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ATIA 2018 Orlando Conference and ExhibitionPre-Conference Seminars: January 30-31 (Separate fee to participate)Exhibit Hall Open: Wednesday, January 31 – Saturday, February 3Conference Sessions: Thursday, February 1 – Saturday, February 3Caribe Royale All Suites Hotel & Convention CenterOrlando, FloridaATTENDEE REGISTRATION FORMPlease print clearly or type (this form may be copied for additional registrants.)First Name:Last Name:Badge Name: Position/Title:Company Name:Address:City/State/Zip Code/Country:Phone: Fax:E-mail:If you need to be accompanied by an assistant, please enter their name here for a complimentary assistantbadge. Please note: assistant registrants are not eligible for continuing education credit.Assistant First Name: Assistant Last Name:Assistant Email:ATIA may use personal identifiable information collected, such as to help minimize any potential hotel attritionpenalties for the association. By registering for the conference you consent to such use. If you have anyquestions or concerns please contact ATIA at registration@atia.org.Check here if you do NOT want to receive e-mails from ATIA Exhibitors and Members with details includingspecial offers or other conference-related materials.If you have any special needs, accommodations, or dietary requests, please detail your requirements below:Please note: Requests for sign interpreters must be made one month in advance of the conference.Unfortunately, requests for sign interpreters after December 29, 2017 will not be accommodated. Sighted guidesare available for one hour periods onsite based on availability. Accessible conference materials will be availablefor download in advance of the conference.ATIA 2018Orlando Attendee Registration Form Page 1
ATTENDEE PROFILE1. Please indicate your attendee category(select all that apply):4. Have you previously attended an ATIAConference?(A) Yes(B) No(A)Accessibility Professional(B)Advocate(C)AT Dealer(D)AT Specialist(A) 1 year(B) 2-5 years(E)Consultant(C) More than 5 years(D) More than 10 years(F)Consumer(G)Education Administrator(H)Federal Government(I)Hard of Hearing/Deaf specialist(J)K-12 educator(K)Occupational therapist(L)Parent(M)Physical therapist(N)Rehabilitation specialist(E) Education/Learning(O)RESNA ATP(F) Physical Access/Mobility(P)Speech-language pathologist(G) Transition/Vocational(Q)Special education director(H) Other (please specify)(R)University affiliate(S)Vision specialist(T)Other (please specify)If yes, please indicate the number of years youhave attended an ATIA Conference:5. Please indicate your interest area(s) (selectall that apply):(A) AAC (Augmentative & AlternativeCommunication)(B) Accessibility(C) Blind/Low Vision(D) Deaf/Hard of Hearing2. Please indicate what most closely describesyour role in purchasing decisions in yourorganization:(A) I am the purchasing decision-maker6. Are you attending the ATIA AnnualConference to earn continuing educationcredits?(A) Yes(B) NoIf yes, what type of continuing education creditapplies to you? (Circle all that apply)(B) I approve purchases(C) I recommend/influence purchasing decisions(D) I am not involved in purchasing decisions3. How did you hear about this conference?(A) ATIA Website(D) Word-of-Mouth(B) AT Vendor(C) Email(E) Advance Program(F) Conferences: AOTA, ASHA, CSUN, CTG,RESNA, Other Conference:(please specify):(G) Other (please specify):ATIA 2018Orlando Attendee Registration Form(A) ACVREP(B) AOTA(C) ASHA(D) Generalist CEUs(E) Other7. Are you interested in attendingedcampAccess International at ATIA 2018? Byselecting yes, your information will be sharedwith the organizers of the edcampAccessInternational unconference.(A) Yes(B) No Page 2
Registration Categories / FeesPlease identify the fees in the proper tier associated with your registration category and include the total below.Pre-Conference Seminars require an additional registration fee.Late 12/2/17 - OnsiteFull Conference Registration includes access to the Exhibit Hall, Wednesday Opening 575.00Reception and Educational Sessions.Group Registration 5 Attendees (discount 5% per person based on attendee fee) 546.25Group Registration 10 Attendees (discount 10% per person based on attendee fee) 517.50Speaker Registration 575.00Parent Registration: 50 % Discount. A letter describing your child’s disability must accompanyyour registration. A letter can be submitted with your registration form.Student Registration: 50% Discount. Proof of your full-time student status must accompanyyour registration. A letter can be submitted with your registration form. 287.50 287.50Exhibit Hall (Wednesday thru Saturday) 0.00Single Day RegistrationOne Day Thursday (includes complimentary Saturday registration) 300.00One Day Friday (includes complimentary Saturday registration) 300.00One Day Saturday 100.00Pre-paid Lunch Ticket: Select Day/s required:Tuesday / Wednesday / Thursday / FridayAOTA CEU Fee (Attendance forms provided online) Note: Complimentary CEUs are providedfor all sessions. Specialist ACVREP and ASHA CEUs are provided for selected sessions at nocost. 18.00 per lunch ticket 15.00Pre-Conference Seminar InformationPre-Conference Seminars are all-day workshops held on Tuesday, January 30 and Wednesday, January 31presented by leading national and international AT professionals. There are separate fees to attend a PreConference Seminar. Pre-Conferences are scheduled from 8:00 AM – 4:00 PM with an hour for lunch from12:00 – 1:00 PM. Complimentary CEUs are available.Two Day Pre-Conference Seminar (1/30-1/31/18)One Day Pre-Conference Seminar (1/31/18)Parent/Student Two Day Pre-Conference Seminar (1/30-1/31/18)Parent/Student One Day Pre-Conference Seminar (1/31/18) 550.00 325.00 385.00 227.50Date/Time: Tuesday, January 30 & Wednesday, January 31, 8:00am – 4:00pmSession Type: Two daySession Code: PRE-1TWStrand: Sensory ImpairmentSession Title: Alternative Technology for People Who Are Blind or Visually ImpairedSpeaker: Ike Presley, National Project Manager, American Foundation for the Blind (AFB); Larry Lewis, Founder,Flying Blind, Inc.; Alyson Gullette, Adjunct Professor, Salus UniveristySession Code: PRE-2TWStrand: Assistive Technology for Improved FunctionSession Title: Communication, Learning and Access: Severe Physical and Multiple ChallengesSpeaker: Linda Burkhart, Independent Consultant, Linda J. BurkhartSession Code: PRE-3TWStrand: Assistive Technology for Improved FunctionSession Title: iPAD Boot Camp – Awesome New Apps, Adaptions and AccessoriesSpeaker: Therese Willkomm, Director of ATinNH, University of New HampshireATIA 2018Orlando Attendee Registration Form Page 3
Session Code: PRE-4TWStrand: LeadershipSession Title: The Changing Role of AT TeamsSpeaker: Gayl Bowser, M.S.Ed., Independent Consultant, Assistive Technology Collaborations; Denise DeCoste,Ed.D., Assistive Technology Specialist/Consultant, Accessible Technology ConsultingSession Code: PRE-5TWStrand: LeadershipSession Title: AT Bootcamp: Foundations Through ImplementationSpeaker: Kelly Fonner, Education/Assistive Technology Consultant, Kelly Fonner Consulting; Mike Cole, Owner,Use Your Words, PC; Kirk Behnke, President, Behnke Consulting, LLCSession Code: PRE-6TWStrand: Education/LearningSession Title: An Eye on Visuals: Supporting Behavior, Learning, Communication and OrganizationSpeaker: Beth Poss, Educational Consultant, Montgomery County Public Schools, Mo Buti, Aiepa: Advocate andInstructional Expert for People with AutismSession Code: PRE-7TWStrand: Education/LearningSession Title: Innovative Technologies for Learners with Reading and Other Learning DifferencesSpeaker: Karen Janowski, MS Ed, Assistive & Educational Technology Consultant, EdTech Solutions;Sharon Plante, LD Technologist, Eagle Hill SouthportSession Code: PRE-8TWStrand: Education/LearningSession Title: Google Bootcamp 2.0Speaker: Mike Marotta, AT Specialist, Inclusive Technology Solutions LLCDate/Time: Wednesday, January 31, 8:00am – 4:00pm Session Type: One daySession Code: PRE-9WStrand: Assistive Technology for Improved FunctionSession Title: Breaking Out the AT Toolkit: A Hands-on ExperienceSpeaker: Lindsey Huntley, SLP, ATP, Speech Supervisor Center for Assistive Technology, NYCDOE Center forAssistive Technology; Maricris Formoso-Santos, PT, ATP, AT Supervisor, NYCDOE Center for AssistiveTechnology, Loreto Dumitrescu, AT Evaluator, NYC DOE Center for Assistive Technology, Mylene Matro, ATEvaluator, NYC DOE Center for Assistive TechnologySession Code: PRE-10WStrand: Education/LearningSession Title: Autism: Engagement and Creative Communication!Speaker: Carol Allen, School Improvement Adviser (ICT and SEN), North Tyneside City Learning CentreSession Code: PRE-11W SOLD-OUTStrand: Education/LearningSession Title: Literacy for All: Instruction for Learners with Complex Communication Needs SOLD-OUTSpeaker: Jessica Caron, Ph.D., CCC-SLP, Assistant Professor, Department of Communication Sciences andDisorders (CSD), Penn State University; David McNaughton, Ph.D., Professor, Educational and School Psychologyand Special Education, Penn State University; Christine Holyfield, Ph.D, CCC-SLP, Assistant Professor,Department of Rehabilitation, Human Resources, and Communication Disorders, University of Arkansas; SalenaBabb, Doctoral Candidate in Special Education, Pennsylvania State UniversityTo be added to the waitlist, please email edefouw@atia.org.Session Code: PRE-12WStrand: Assistive Technology for Improved FunctionSession Title: Head, Shoulders, Knees, and Toes: Assistive Technology Access and AssessmentSpeaker: Douglene Jackson, PhD, OTR/L, LMT, ATP, Occupational Therapist, University of Miami-Mailman Centerfor Child DevelopmentSession Code: PRE-13WStrand: Sensory ImpairmentSession Title: Practitioner’s Handbook on Technology Implementation for People with Visual ImpairmentsSpeaker: Rachael Sessler Trinkowsky, Ph.D., CRC, CATIS, Technology Training and Vocational Coordinator,Lighthouse for the Blind of the Palm BeachesATIA 2018Orlando Attendee Registration Form Page 4
5 WAYS TO REGISTERONLINE: www.atia.org/registerFAX: 847-277-7414EMAIL: registration@atia.orgTELEPHONE: 847-620-4471MAIL: ATIA Registration, 8324 Solutions Center, Chicago, IL 60677-8003Full payment must accompany registrations.Check (payable to ATIA)registration)MCVisaATIA Federal ID#: 77-0482095AMEXPurchase Order (Original PO must accompanyTotal Fees Due: Discount Code (if applicable):Check/Card/PO# Exp Date CVV CodeName on card (please print)Signature:If you submit this form via fax, email, online, or mail, you are agreeing to the cancellation policy and thepurchase payment policy.Cancellation Policy: A full refund will be granted to cancellations made in writing on or before Monday,November 27, 2017. Name changes and substitutions are allowed at no fee. Regrettably, no refunds will begiven on cancellations received on or after Tuesday, November 28, 2017. Phone cancellations will not beaccepted. Written cancellations must be sent by email to registration@atia.org or faxed to 1 847-277-7414.Purchase Order Payment Policy: If your organization is required to submit a purchase order for payment,please send your purchase order document with all pages of the registration form. Registrations paid bypurchase order are subject to the Cancellation Policy. Purchase order payments are due no later than 30 daysafter the completion of the conference, by Friday, March 2, 2018. Payments received after March 2, 2018, willincur a 75 late payment fee.If any circumstances or event beyond the control of ATIA causes cancellation of all or any portion of the event,ATIA agrees to refund any portion of the registration fee which ATIA is reimbursed by insurance or other thirdparty and shall not be liable for any other refund or payment arising from the cancellation or for other liability ordamages arising from the event.Please Note: On occasion, an ATIA photographer may take photos of participants at ATIA Orlando 2018, or ofpeople participating in conference functions or activities. Please be aware that these photos are for ATIA’s useonly, and may appear in ATIA conference programs, brochures, newsletters, website and other publicationsand materials. Your attendance constitutes your permission and consent for this photography and subsequentusage.ATIA 2018Orlando Attendee Registration Form Page 5
Babb, Doctoral Candidate in Special Education, Pennsylvania State University To be added to the waitlist, please email edefouw@atia.org. Session Code: PRE-12W Strand: Assistive Technology for Improved Function Session Title: Head, Shoulders, Knees, and Toes: Assistive Technology Access and Assessment
